Glycemic Control and All-Cause Mortality Risk in Type 1 Diabetes Patients: The EURODIAB Prospective Complications Study
Identifieur interne : 004138 ( Main/Exploration ); précédent : 004137; suivant : 004139Glycemic Control and All-Cause Mortality Risk in Type 1 Diabetes Patients: The EURODIAB Prospective Complications Study
Auteurs : Danielle A. J. M. Schoenaker [Australie, France] ; Dominique Simon [France] ; Nish Chaturvedi [Royaume-Uni] ; John H. Fuller [Royaume-Uni] ; Sabita S. Soedamah-Muthu [Pays-Bas]Source :
- The Journal of clinical endocrinology and metabolism [ 0021-972X ] ; 2014.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Mortalité, Homme, Prospective, Nutrition.
English descriptors
- KwdEn :
Abstract
Context: Glycemic targets and the benefit of intensive glucose control are currently under debate because intensive glycemic control has been suggested to have negative effects on mortality risk in type 2 diabetes patients. Objective: We examined the association between glycated hemoglobin (HbA1c) and all-cause mortality in patients with type 1 diabetes mellitus. Design, Setting, and Patients: A clinic-based prospective cohort study was performed in 2764 European patients with type 1 diabetes aged 15-60 years enrolled in the EURODIAB Prospective Complications Study. Outcome Measure: Possible nonlinearity of the association between HbA,, and all-cause mortality was examined using multivariable restricted cubic spline regression using three (at HbA1c 5.6%, 8.1%, and 11.8%) and five knots (additionally at HbA1c 7.1% and 9.5%). Mortality data were collected approximately 7 years after baseline examination. Results: HbA1c was related to all-cause mortality in a nonlinear manner after adjustment for age and sex. All-cause mortality risk was increased at both low (5.6%) and high (11.8%) HbA1c compared with the reference (median HbA1c: 8.1%) following a U-shaped association [Poverall effect = .008 and .04, P nonlinearity = .03 and .11 (three and five knots, respectively)]. Conclusions: Results from our study in type 1 diabetes patients suggest that target HbA1c below a certain threshold may not be appropriate in this population. We recognize that these low HbA1c levels may be related to anemia, renal insufficiency, infection, or other factors not available in our database. If our data are confirmed, the potential mechanisms underlying this increased mortality risk among those with low HbA1c will need further study.
Affiliations:
- Australie, France, Pays-Bas, Royaume-Uni
- Angleterre, Grand Londres, Gueldre (province), Île-de-France
- Londres, Paris, Wageningue
- University College de Londres, Université de Wageningue
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Schoenaker</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>School of Population Health, University of Queensland</s1><s2>Brisbane, 4006 Queensland</s2><s3>AUS</s3><sZ>1 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Brisbane, 4006 Queensland</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Diabetes, la Pitié Hospital and University Pierre et Marie Curie</s1><s2>75013 Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>75013 Paris</wicri:noRegion><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName></affiliation></author><author><name sortKey="Simon, Dominique" sort="Simon, Dominique" uniqKey="Simon D" first="Dominique" last="Simon">Dominique Simon</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>INSERM CESP, U-1018</s1><s2>94805 Villejuif</s2><s3>FRA</s3><sZ>2 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>94805 Villejuif</wicri:noRegion><wicri:noRegion>U-1018</wicri:noRegion><wicri:noRegion>94805 Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Chaturvedi, Nish" sort="Chaturvedi, Nish" uniqKey="Chaturvedi N" first="Nish" last="Chaturvedi">Nish Chaturvedi</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>National Heart and Lung Institute, Imperial College London</s1><s2>London W2 1PG</s2><s3>GBR</s3><sZ>3 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>London W2 1PG</wicri:noRegion></affiliation></author><author><name sortKey="Fuller, John H" sort="Fuller, John H" uniqKey="Fuller J" first="John H." last="Fuller">John H. 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J. M." last="Schoenaker">Danielle A. J. M. Schoenaker</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>School of Population Health, University of Queensland</s1><s2>Brisbane, 4006 Queensland</s2><s3>AUS</s3><sZ>1 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Brisbane, 4006 Queensland</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Diabetes, la Pitié Hospital and University Pierre et Marie Curie</s1><s2>75013 Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>75013 Paris</wicri:noRegion><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName></affiliation></author><author><name sortKey="Simon, Dominique" sort="Simon, Dominique" uniqKey="Simon D" first="Dominique" last="Simon">Dominique Simon</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>INSERM CESP, U-1018</s1><s2>94805 Villejuif</s2><s3>FRA</s3><sZ>2 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>94805 Villejuif</wicri:noRegion><wicri:noRegion>U-1018</wicri:noRegion><wicri:noRegion>94805 Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Chaturvedi, Nish" sort="Chaturvedi, Nish" uniqKey="Chaturvedi N" first="Nish" last="Chaturvedi">Nish Chaturvedi</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>National Heart and Lung Institute, Imperial College London</s1><s2>London W2 1PG</s2><s3>GBR</s3><sZ>3 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>London W2 1PG</wicri:noRegion></affiliation></author><author><name sortKey="Fuller, John H" sort="Fuller, John H" uniqKey="Fuller J" first="John H." last="Fuller">John H. Fuller</name><affiliation wicri:level="4"><inist:fA14 i1="05"><s1>Department of Epidemiology and Public Health, University College London</s1><s2>London WC1E 6BT</s2><s3>GBR</s3><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">University College de Londres</orgName></affiliation></author><author><name sortKey="Soedamah Muthu, Sabita S" sort="Soedamah Muthu, Sabita S" uniqKey="Soedamah Muthu S" first="Sabita S." last="Soedamah-Muthu">Sabita S. Soedamah-Muthu</name><affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Division of Human Nutrition, Wageningen University</s1><s2>6700 EV Wageningen</s2><s3>NLD</s3><sZ>5 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Wageningue</settlement><region nuts="2">Gueldre (province)</region></placeName><orgName type="university">Université de Wageningue</orgName></affiliation></author></analytic><series><title level="j" type="main">The Journal of clinical endocrinology and metabolism</title><title level="j" type="abbreviated">J. clin. endocrinol. metab.</title><idno type="ISSN">0021-972X</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">The Journal of clinical endocrinology and metabolism</title><title level="j" type="abbreviated">J. clin. endocrinol. metab.</title><idno type="ISSN">0021-972X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Autoimmune disease</term><term>Cause</term><term>Complication</term><term>Endocrinology</term><term>Epidemiology</term><term>Europe</term><term>Evolution</term><term>Glycemia</term><term>Glycemic control</term><term>Human</term><term>Insulin resistance</term><term>Metabolic diseases</term><term>Mortality</term><term>Nutrition</term><term>Nutritional status</term><term>Patient</term><term>Prospective</term><term>Risk</term><term>Risk factor</term><term>Type 1 diabetes</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Insulinorésistance</term><term>Glycémie</term><term>Cause</term><term>Diabète de type 1</term><term>Mortalité</term><term>Epidémiologie</term><term>Facteur risque</term><term>Risque</term><term>Maladie autoimmune</term><term>Homme</term><term>Malade</term><term>Evolution</term><term>Europe</term><term>Complication</term><term>Prospective</term><term>Endocrinologie</term><term>Maladie métabolique</term><term>Nutrition</term><term>Etat nutritionnel</term><term>Contrôle glycémique</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Mortalité</term><term>Homme</term><term>Prospective</term><term>Nutrition</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Context: Glycemic targets and the benefit of intensive glucose control are currently under debate because intensive glycemic control has been suggested to have negative effects on mortality risk in type 2 diabetes patients. Objective: We examined the association between glycated hemoglobin (HbA<sub>1c</sub>) and all-cause mortality in patients with type 1 diabetes mellitus. Design, Setting, and Patients: A clinic-based prospective cohort study was performed in 2764 European patients with type 1 diabetes aged 15-60 years enrolled in the EURODIAB Prospective Complications Study. Outcome Measure: Possible nonlinearity of the association between HbA,, and all-cause mortality was examined using multivariable restricted cubic spline regression using three (at HbA<sub>1c</sub> 5.6%, 8.1%, and 11.8%) and five knots (additionally at HbA<sub>1c</sub> 7.1% and 9.5%). Mortality data were collected approximately 7 years after baseline examination. Results: HbA<sub>1c</sub> was related to all-cause mortality in a nonlinear manner after adjustment for age and sex. All-cause mortality risk was increased at both low (5.6%) and high (11.8%) HbA<sub>1c</sub> compared with the reference (median HbA<sub>1c</sub>: 8.1%) following a U-shaped association [Poverall effect = .008 and .04, P nonlinearity = .03 and .11 (three and five knots, respectively)]. Conclusions: Results from our study in type 1 diabetes patients suggest that target HbA<sub>1c</sub> below a certain threshold may not be appropriate in this population. We recognize that these low HbA<sub>1c</sub> levels may be related to anemia, renal insufficiency, infection, or other factors not available in our database. If our data are confirmed, the potential mechanisms underlying this increased mortality risk among those with low HbA<sub>1c</sub> will need further study.</div></front></TEI><affiliations><list><country><li>Australie</li><li>France</li><li>Pays-Bas</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Gueldre (province)</li><li>Île-de-France</li></region><settlement><li>Londres</li><li>Paris</li><li>Wageningue</li></settlement><orgName><li>University College de Londres</li><li>Université de Wageningue</li></orgName></list><tree><country name="Australie"><noRegion><name sortKey="Schoenaker, Danielle A J M" sort="Schoenaker, Danielle A J M" uniqKey="Schoenaker D" first="Danielle A. J. M." last="Schoenaker">Danielle A. J. M. Schoenaker</name></noRegion></country><country name="France"><region name="Île-de-France"><name sortKey="Schoenaker, Danielle A J M" sort="Schoenaker, Danielle A J M" uniqKey="Schoenaker D" first="Danielle A. J. M." last="Schoenaker">Danielle A. J. M. Schoenaker</name></region><name sortKey="Simon, Dominique" sort="Simon, Dominique" uniqKey="Simon D" first="Dominique" last="Simon">Dominique Simon</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Chaturvedi, Nish" sort="Chaturvedi, Nish" uniqKey="Chaturvedi N" first="Nish" last="Chaturvedi">Nish Chaturvedi</name></noRegion><name sortKey="Fuller, John H" sort="Fuller, John H" uniqKey="Fuller J" first="John H." last="Fuller">John H. Fuller</name></country><country name="Pays-Bas"><region name="Gueldre (province)"><name sortKey="Soedamah Muthu, Sabita S" sort="Soedamah Muthu, Sabita S" uniqKey="Soedamah Muthu S" first="Sabita S." last="Soedamah-Muthu">Sabita S. Soedamah-Muthu</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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